INTRODUCTION
In the last years, the subcutaneous implantable cardioverter defibrillator (S-ICD) has become an established option to prevent sudden cardiac death in patients showing high-risk of infection due to diabetes, chronic kidney disease (CKD), previous cardiac implantable electronic device (CIED) infections, mechanical heart valves, heart failure, immunological disorders, use of anticoagulants or immunosuppressant drugs1,2. Mostly in the same clinical scenario, absorbable antibacterial envelopes (AAE), as per International Guidelines3, are recommended, although data on their use with S-ICDs are currently lacking and they have only been validated with transvenous (TV) ICDs. Although S-ICD related infectious complications resulting into device replacement or lead extraction can be managed easily when compared to TV-ICDs, S-ICDs have failed to show overall lower rates of infection and are indeed associated with a higher risk of pocket complications4. In the present manuscript we aimed to assess the feasibility of a combined deployment of AAEs and S-ICD in selected patients at very high-risk of infections and the infectious outcomes of this specific strategy.